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Champions in usage of medial unicompartmental knee arthroplasty

The story behind the Danish success

Champions im Einsatz der medialen unikompartimentellen Knieendoprothese

Die Geschichte hinter dem dänischen Erfolg

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Abstract

Historically, the use of medial unicompartmental knee arthroplasty (mUKA) as treatment for end-stage anteromedial osteoarthritis (AMOA) of the knee was limited by contraindications due to age, weight, and activity level; however, now evidence-based, validated, and less selective criteria are used rendering nearly 50% of end-stage OA patients eligible for mUKA. Recent studies have showcased benefits, such as shorter hospital stays, cost efficiency, and comparable functional outcomes to total knee arthroplasty (TKA). Notably, revision rates have been shown to markedly decrease with increased usage, with an ideal usage of > 30% but an acceptable usage of 20–60%. The usage of unicompartmental knee arthroplasty (UKA) varies among countries, with Denmark achieving a notably higher usage compared to Sweden, the UK, the Netherlands, the USA and Germany. This article investigates potential factors contributing to Denmark having a higher national usage of mUKA, surpassing the recommended threshold of a usage > 20%. We explore the tradition for national alliances and streamlined surgical education as possible explanations of this development. These insights offer valuable perspectives for potentially optimizing surgical approaches and implant choices in the surgical treatment of end-stage AMOA of the knee across diverse healthcare settings, underscoring the impact of collective strategies in advancing knee arthroplasty practices, ultimately benefiting patients.

Zusammenfassung

In der Vergangenheit war der Einsatz der medialen unikompartimentellen Knietotalendoprothese (Knie-TEP) zur Behandlung der anteromedialen Arthrose (AMA) des Knies im Endstadium durch Kontraindikationen aufgrund von Alter, Gewicht und Aktivitätsniveau eingeschränkt. Heute werden jedoch evidenzbasierte, validierte und weniger selektive Kriterien verwendet, so dass fast 50 % der Patienten mit Arthrose im Endstadium für eine unikompartimentellen Knie-TEP in Frage kommen. Neuere Studien haben Vorteile wie kürzere Krankenhausaufenthalte, Kosteneffizienz und vergleichbare funktionelle Ergebnisse wie bei der Knie-TEP aufgezeigt. Insbesondere hat sich gezeigt, dass die Revisionsraten mit zunehmendem Einsatz deutlich sinken, wobei ein idealer Einsatz von >30 %, aber ein akzeptabler Einsatz von 20−60 % erreicht wird. Der Einsatz der unikompartimentellen Knieendoprothetik variiert von Land zu Land, wobei Dänemark im Vergleich zu Schweden, Großbritannien, den Niederlanden, den USA und Deutschland einen deutlich höheren Einsatz aufweist. In diesem Artikel werden mögliche Faktoren untersucht, die dazu beitragen, dass Dänemark einen höheren nationalen Einsatz von Knie-TEP aufweist und den empfohlenen Schwellenwert von >20 % überschreitet. Wir untersuchen die Tradition der nationalen Allianzen und die gestraffte chirurgische Ausbildung als mögliche Erklärungen für diese Entwicklung. Diese Erkenntnisse bieten wertvolle Perspektiven für eine mögliche Optimierung der chirurgischen Ansätze und der Implantatauswahl bei der chirurgischen Behandlung von Gonarthrose im Endstadium in verschiedenen Gesundheitssystemen und unterstreichen den Einfluss kollektiver Strategien auf die Weiterentwicklung der Knieendoprothetik, was letztlich den Patienten zugutekommt.

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Abbreviations

ACL:

Anterior cruciate ligament

AMOA:

Anteromedial osteoarthritis

AP:

Anteroposterior

mUKA:

Medial unicompartmental knee arthroplasty

OA:

Osteoarhtritis

TKA:

Total knee arthroplasty

UKA:

Unicompartmental

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Authors and Affiliations

  1. Clinical Orthopedic Research Hvidovre, Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Kettegårds Alle 30, 2650, Hvidovre, Denmark

    Anne Louise Elkjær Christensen, Christian Bredgaard Jensen, Kirill Gromov & Anders Troelsen

  2. The Danish Clinical Quality Program—National Clinical Registries (RKKP), Odense, Denmark

    Troels Mark-Christensen

  3. Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    Martin Lindberg-Larsen

Authors
  1. Anne Louise Elkjær Christensen
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  2. Christian Bredgaard Jensen
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  3. Kirill Gromov
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  4. Troels Mark-Christensen
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  5. Martin Lindberg-Larsen
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  6. Anders Troelsen
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Corresponding author

Correspondence to Anne Louise Elkjær Christensen.

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Conflict of interest

A.L. Elkjær Christensen has received grant salary from Novo Nordisk Foundation as research assistant on a study not related to this study. C. Bredgaard Jensen has received PhD scholarship from Novo Nordisk Foundation related to another project and serves as a board member for Young Orthopaedic Danish Association (YODA). K. Gromov has received research support and institutional support from Zimmer Biomet, unrelated to this project. T. Mark-Christensen is a consultant for the Danish Knee Arthroplasty Register. M. Lindberg-Larsen serves as chairman for the Danish Knee Arthroplasty Register. A. Troelsen serves as advisory board member and receives consultancy fees from Zimmer Biomet and Pfizer Denmark and has received payment for lectures including service on speaker bureaus from Zimmer Biomet. A. Troelsen has received research support from Zimmer Biomet and Pfizer Denmark and received travel, accommodation, meeting expenses from Zimmer Biomet.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Elkjær Christensen, A.L., Bredgaard Jensen, C., Gromov, K. et al. Champions in usage of medial unicompartmental knee arthroplasty. Orthopädie 53, 246–254 (2024). https://doi.org/10.1007/s00132-024-04477-8

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